2010 BC Guide in Determining Fitness to Drive

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Chapter 30: General Debility and Lack of StaminaBACKGROUND30.1 About general debility and lack of staminaGeneral debilityGeneral debility is a state of general weakness or feebleness that may be a result or an outcomeof one or more medical conditions that produce symptoms such as pain, fatigue, cachexia andphysical disability, or cognitive symptoms of attention, concentration, memory, developmentaland/or learning deficits.Some of the medical conditions included in this part of the Manual may be commonly associatedwith general debility, e.g. end stage renal disease, and in these cases this is noted in the medicalcondition chapter. However, general debility is more usually associated with multiple medicalconditions or extreme old age. Medications used to treat various medical conditions may alsoproduce effects that contribute to general debility.Common medical conditions not included in this Manual that may result in general debility are: anorexia nervosa or other related eating disorders chronic fatigue syndrome malabsorption syndromes (e.g. cystic fibrosis, Crohn’s disease) and malnutrition AIDS chronic infections, e.g. TB or HIV malignancies, and conditions resulting in chronic pain.Lack of staminaStamina is the physical or mental strength to resist fatigue and tiredness and maintain functionalability over time. Lack of stamina is not the same as general debility. While drivers withgeneral debility do not have sufficient stamina to drive, drivers suffering from a lack of staminamay not be suffering from general debility.Generally, concerns about stamina only arise in extreme old age or when a driver has a conditionthat results in a persistent impairment. For drivers with co-morbidities, stamina may be aparticular concern.Some of the medical conditions in this part of the Manual may be commonly associated with alack of stamina, e.g. congestive heart failure, and in these cases this is noted in the medicalcondition chapter.366
30.2 Effect of general debility and lack of stamina on functional ability to driveBoth a lack of stamina and general debility may impair an individual’s motor and/or cognitivefunctions necessary for driving.A person suffering from a lack of stamina may experience: fatigue physical disability, and/or cognitive impairment such as loss of attention, concentration and memory.A person suffering from general debility may experience: pain fatigue / poor stamina cachexia - a condition marked by loss of appetite, weight loss, muscular wasting, andgeneral mental and physical debilitation physical disability, and/or cognitive impairment such as loss of attention, concentration and memory.ConditionType of drivingimpairment andassessmentapproachPrimaryfunctionalability affectedAssessment toolsGeneral debilityLack of staminaPersistentImpairment:FunctionalassessmentCognitiveDriver’s Medical ExaminationReportCognitive screening tools suchas; MOCA, MMSE, SIMARD-MD, Trails A or BDriveABLE assessmentMotorDriver’s Medical ExaminationReportICBC road test30.3 CompensationAn individual cannot compensate for general debility or a lack of stamina that impairs thefunctions necessary for driving.367
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Ministry of Public Safety and Solic
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AcknowledgmentsResearcherBonnie M.
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Table of Contents (click on any ite
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11.7 Private and commercial drivers
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BACKGROUND ........................
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PART 1:BACKGROUND1
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Appendix 2: Excerpts from the MVA t
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Chapter 2: The Driver Fitness Progr
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for the exercise of discretion by O
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1. SCREENINGA driver disclosesa med
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2.3 Roles and responsibilitiesOSMV
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Medical practitionersMedical practi
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Chapter 3:Driver Fitness Program Pr
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Because of these limitations, OSMV
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Example: the temporary storage of i
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Motor functions (including sensorim
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an individual with poor contrast se
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3.5 Best informationDriver fitness
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Chapter 4: Introduction to the Poli
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3. DETERMINATIONFrom2. AssessmentAn
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Once identified, a DMER is mailed t
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5.3 Screening aging driversDefiniti
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5.5 Transient impairmentsDefinition
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Chapter 6: Assessment Policies and
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6.2 Assessments will only be reques
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6.4 Requesting specialist assessmen
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Policy6.5.1 If a case manager or ad
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Persistent and episodic impairments
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further assessment. Drivers who sco
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6.9.4 A case manager or adjudicator
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ASSESSMENT PROCEDURESCase manager o
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A driver fitness determination is a
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Policy rationaleBecause individuals
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7.5.3 Generally, an individual whos
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7.6.2 In particular, the case manag
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7.8.3 Whether an individual can com
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in order to be fit to drive, the ca
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has the judgment and willingness to
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Policy7.11.1 If a case manager or a
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(e) the medical condition results i
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7.12 Communicating a decisionPolicy
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7.13 Determination proceduresThe fo
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During the reconsideration, the adj
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8.3 Reconsideration proceduresThe f
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Chapter 9:Introduction to the Medic
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9.4 Medical condition chapter templ
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Private and commercial drivers who
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Chapter 11: Diabetes - Hypoglycemia
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PercentFigure 1 - Prevalence of Dia
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neuropathy, nephropathy, cardiovasc
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11.8 Private drivers with diabetes
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11.9 Commercial drivers with diabet
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RestrictionsRe-assessmentguidelines
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Policy rationaleSevere hypoglycemia
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11.12 Private drivers who have pers
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11.13 Commercial drivers who have a
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11.14 Commercial drivers who have a
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11.15 Commercial drivers who have p
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PART B - HYPOGLYCEMIA11a. Has the p
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Produce my glycemic log for my doct
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Deep-vein thrombosisDeep-vein throm
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Aneurysms less than 5 cm in diamete
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GUIDELINES12.6 Private and commerci
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12.7 Private drivers who have an an
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12.9 Commercial drivers who have an
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Chapter 13: Musculoskeletal Conditi
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ConditionType of drivingimpairment
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ConditionsRestrictionsRe-assessment
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14.3 Chronic renal disease and adve
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14.8 Private drivers with end-stage
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14.10 Private and commercial driver
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Level ofImpairmentMildlyImpairedMod
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15.8 Commercial drivers with modera
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15.10 Commercial drivers with sever
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Policy rationaleDrivers who require
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Chapter 16: Vestibular DisordersBAC
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One study identified that 32.5% of
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ConditionType ofdrivingimpairmentan
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Re-assessmentguidelinesPolicy ratio
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Individuals who have undergone valv
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Episodic impairmentThe potential ep
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GUIDELINES17.6 Policy rationaleThes
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17.9 Commercial drivers with corona
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17.11 Private drivers who have had
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17.15 Private drivers who have vent
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17.19 Private drivers who have sust
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17.21 Commercial drivers who have s
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17.27 Private drivers with atrioven
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17.28 Commercial drivers with atrio
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17.29 Private drivers with permanen
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17.31 Private drivers who have decl
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17.33 Private drivers where ICD the
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17.35 Commercial drivers who have d
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17.37 Commercial drivers with inher
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17.39 Commercial drivers with medic
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17.41 Private drivers with surgical
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17.43 Private drivers with mitral v
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17.45 Private drivers with congesti
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17.46 Commercial drivers with conge
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17.47 Private drivers with left ven
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17.49 Private drivers with a heart
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17.51 Private drivers with hypertro
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17.53 SyncopeSee the guidelines in
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Stable coronary syndromes - waiting
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Chapter 18: Hearing LossBACKGROUND1
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GUIDELINES18.6 Private drivers with
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equirement for commercial drivers i
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PLEASE COMPLETE THE FOLLOWING: YES
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this manual. Axis IV addresses exte
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Negative symptoms are characterized
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Schizophrenia (Axis I)Schizophrenia
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19.4 Effect of psychiatric disorder
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Suicidal ideationSuicidal ideation
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Chapter 20: Cerebrovascular Disease
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Cerebrovascular accidentCVAs are th
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Re-assessmentguidelinesPolicy ratio
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20.9 Private drivers who have had s
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20.10 Commercial drivers who have h
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Visual field impairment refers to a
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Right homonymous hemianopiaBinasal
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An example of the effects of diabet
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Retinitis pigmentosaRetinitis pigme
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GlaucomaApproximately 67 million pe
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indicates that wait times of 6 mont
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Although telescopic spectacles, hem
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Policy rationaleretinopathy dependi
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Policy rationaleIndividuals with be
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Re-assessmentguidelines cont’dPol
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Re-assessmentguidelines cont’dPol
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21.13 Commercial drivers with a los
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21.17 Visual field impairmentsTypes
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21.18 Examination of visual functio
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VISUAL FIELD TEST (VFT)For drivers
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To the Driver:Under section 29 of t
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Please note:Goldman, Esterman and H
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Cardiac syncopeCardiac syncope refe
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22.7 Private drivers who have had a
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22.9 Private drivers with recurrent
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22.11 Commercial drivers who have h
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22.13 Commercial drivers with recur
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Chapter 23: Seizures and EpilepsyBA
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abnormal numbnesstingling and a cra
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23.10 Private drivers with single u
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23.12 Private drivers with epilepsy
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Page 337 and 338: ConditionsRestrictionsRe-assessment
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Page 341 and 342: GUIDELINES25.6 Private and commerci
Page 343 and 344: Chapter 26: Intracranial TumoursBAC
Page 345 and 346: Some examples of compensatory mecha
Page 347 and 348: Re-assessmentguidelinesPolicy ratio
Page 349 and 350: i. aphasia (language disturbance)ii
Page 351 and 352: 27.2 Prevalence and incidence of co
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Page 355 and 356: Chapter 28: Sleep DisordersBACKGROU
Page 357 and 358: An immediate reduction in daytime s
Page 359 and 360: 28.5 CompensationIndividuals with s
Page 361 and 362: OSMV determinationguidelines cont
Page 363 and 364: ConditionsRestrictionsRe-assessment
Page 365 and 366: Policy rationaleThe general approac
Page 367 and 368: Chapter 29: Prescription and Over-T
Page 369 and 370: Examples of newer antihistamines in
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Page 375 and 376: Sedating EffectLowModerateHighTCAsd
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Page 379: Re-assessmentguidelinesPolicy ratio
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Page 385 and 386: Appendix 1: Glossary of TermsCommer
Page 387 and 388: Medical assessmentis any kind of as
Page 389 and 390: Transient impairmentmeans a tempora
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Page 395 and 396: Appendix 3: Aging DriversAbout agin
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Page 399 and 400: Appendix 4: Licence ClassesThe tabl
Page 401 and 402: Appendix 5: Drafting and Approval P
Page 403: drivers, this means that BC commerc
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2010 BC Guide in Determining Fitness to Drive

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